Incidence of Significant Tricuspid Regurgitation in Patients with Right Ventricular Outflow Tract Dysfunction and Impact of Percutaneous Pulmonary Valve Implantation on Tricuspid Valve Function

  • Philipp Lurz, UCL Institute of Child Health and Great Ormond Street Hospital for Sick Children, United Kingdom
  • Johannes Nordmeyer, UCL Institute of Child Health and Great Ormond Street Hospital for Sick Children, Germany
  • Sachin Khambadkone, UCL Institute of Child Health and Great Ormond Street Hospital for Sick Children, India
  • Vivek Muthurangu, UCL Institute of Child Health and Great Ormond Street Hospital for Sick Children, United Kingdom
  • Silvia Schievano, UCL Institute of Child Health and Great Ormond Street Hospital for Sick Children, Italy
  • Dr Philipp Bonhoeffer, UCL Institute of Child Health & Great Ormond Street Hospital for Children, United Kingdom
  • Andrew Taylor, UCL Institute of Child Health and Great Ormond Street Hospital for Sick Children, Germany

    • Background:
    Percutaneous pulmonary valve implantation (PPVI) is a less invasive strategy to treat right ventricle (RV) to pulmonary artery (PA) conduit dysfunction. However, in contrast to surgery, concomitant tricuspid valve lesions cannot be treated with this technique. Therefore, we analysed the incidence of significant tricuspid regurgitation in patients with RV to PA conduit dysfunction and the impact of PPVI on tricuspid valve function.

    Methods:
    Magnetic resonance (MR) imaging including biventricular volumes and great vessel blood flow assessment was performed prior to and immediately after PPVI in 146 patients. Retrospectively, out of this patient population, we selected patients who had a tricuspid regurgitation fraction (TRF) > 10% on MR prior to valve implantation. TRF was calculated from right ventricular stroke volume and pulmonary artery forward flow.

    Results:
    16 patients had a tricuspid regurgitation fraction > 10% (incidence 10.9%). After PPVI, the gradient across the conduit fell from 40.8±12.4 mmHg to 15.9±5.3 mmHg (p<0.001). In addition, there was a decrease in RV end-diastolic volumes (113.3±20.8 ml/m2 to 89.3±19.6 ml/m2, p<0.001) and pulmonary regurgitation fraction (16.6±14.6% to 1.9±2.7%, p<0.024) on MR. Reduction in RV pressure and/or volume overload was associated with a significant reduction in TRF (25.4±6.4 % to 8.2±3.7 %, p<0.001).

    Conclusion:
    Significant tricuspid regurgitation in the context of RV to PA conduit dysfunction is not common. Further, relief in RV volume and pressure overload by PPVI improves tricuspid valve function acutely. This is important, when patients are selected for either surgical or percutaneous treatment of RV to PA conduit dysfunction.